PB2091: DISPARITIES IN ENROLMENT INTO MULTIPLE MYELOMA CLINICAL TRIALS BY SOCIOECONOMIC DEPRIVATION
Authors: Amrutha Sridhar, Selina Chavda, Hannah Hsu, Hanna Renshaw, Tatianna Fernandes, Catriona Maciter, Samir Asher, Neil Rabin, Jonathan Sive, Charalampia Kyriakou, Xenofon Papanikolaou, Ke Xu, Ashutosh Wechalekar, Shameem Mahmood, Annabel Mcmillan, Lydia Lee, Kwee Yong, Fatjon Dekaj, Rakesh Popat
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Disparities in patients enrolled into clinical trials compared to real world populations have been reported, particularly with underrepresentation of different racial groups. However, disparities in clinical trial access may also relate to socioeconomic factors. Social deprivation has been shown to impact overall survival (OS) of multiple myeloma (MM) patients, and hence adequate sociodemographic representation is required for clinical trials to be truly informative. Aims: To identify the distribution of patients enrolled into MM clinical trials according to social deprivation and understand interactions with race, prognostic markers, and OS. Methods: This was a single centre retrospective analysis of MM patients treated between 2014-2023 from electronic medical records. Social deprivation was assessed by postcode using the English Indices of Multiple Deprivation (IMD) ranking, derived from income, employment, health, education, housing barriers, services, crime, and living environment. Comparator data for MM incidence by social deprivation in London and England was obtained from the National Cancer Registration and Analysis Service (NCRAS, 2006-2015). OS was estimated using Kaplan Meier Curves and correlative analysis by Cox regression models with GraphPad prism V9. Results: 580 consecutive patients at a single UK centre (University College London Hospital) receiving referrals from a wide geographical area were analysed. Patients were grouped in 3 cohorts: standard of care (SOC, n=212), clinical trials (n=355): early phase trials (EPT, Phase I/II, n=103) late phase trials (LPT, Phase II & III, n=252). Median age was 66 years (35-90), M:F ratio was 1.3:1 and had a median of 3 prior lines (0-14). 406 (70%) were White, 80 (13.8%) Black, 40 (6.9%) Asian, 38 (6.6%) Mixed/Other and 16 (2.8%) unknown. There was a significant difference in social deprivation ranking between those enrolled into clinical trials compared to that expected for England, with fewer patients from more deprived areas being enrolled(p=<0.0001, Table 1), in both EPT and LPT groups. External referrals comprised almost half of the trials cohort (n=169, 47.6%) and were chiefly from less deprived areas compared to NCRAS data for England (p=0.02). LPT patients from more deprived areas had an inferior OS to those from less deprived areas (p=0.03), although this was not observed for EPT (p=0.82). The distribution of SOC patients was also from less deprived areas than expected for London (p<0.0001) indicating that patient referrals were skewed rather than the selection of referred patients for trials. Overall the non-white trial patients were from more deprived areas than white patients (p=0.018), predominantly in the LPT group (p=0.003). No difference in social deprivation (p=0.25) was noted between white and non-white EPT patients. Whilst white patients were from less deprived areas than non-whites, there was a significantly negative OS in the socially deprived white patient group (p=0.04). This was not observed in non-white patients. Patients aged ≥ 75 with worse social deprivation indices had an inferior OS (p=0.01). This was not observed in those aged <75. Summary/Conclusion: Patients enrolled into clinical trials at our centre were from less socially deprived areas than expected from the distribution of MM in London and England, reflecting skewed referral patterns by socioeconomic status. As these differences may impact upon overall survival, it is vital that enrolment into clinical trials is monitored by socioeconomic deprivation to ensure there is adequate representation of the geographical population.Keywords: Clinical trial, Phase I/II, Multiple myeloma, Survival